Estimating the prevalence of chronic fatigue syndrome and associated symptoms in the community.
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Chronic fatigue syndrome is a poorly understood disease characterized by debilitating fatigue and neuromuscular and neuropsychological symptoms. Despite numerous studies on the subject, the epidemiology of the syndrome in the community remains largely unexplored. An estimate of the prevalence in the population is presented, approximating the Centers for Disease Control criteria as well as the prevalence estimates of the fatigue symptom complex that include fatigue, disability, and neuromuscular and neuropsychological symptoms. The study population consisted of a very large, multicenter, stratified, and random sample of a general population health survey known as the Epidemiologic Catchment Area Program. Data used for this study were gathered between 1981 and 1984. The Diagnostic Interview Schedule, a highly structured mental health interview, was used to assess the lifetime prevalence of medical and psychological symptoms. Chronic fatigue was common. A total of 23 percent of the subjects reported having experienced the symptom of persistent fatigue sometime during their lives. Chronic fatigue syndrome, however, as defined by the Centers for Disease Control, appeared to be quite rare in the general population. Only 1 of 13,538 people examined was found to meet a diagnosis of the syndrome with an approximation of the CDC criteria. Fatigue symptom complex was frequently related to medical or psychiatric illness or substance abuse; thus, persons meeting partial criteria of chronic fatigue syndrome were also found to be rare when psychiatric or medical exclusions were applied. (+info)
Determinants of depressive symptoms in the early weeks after miscarriage.
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OBJECTIVES: We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS: We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS: Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS: Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy. (+info)
Headache complaints associated with psychiatric comorbidity in a population-based sample.
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The objective of the present study was to determine the frequency at which people complain of any type of headache, and its relationship with sociodemographic characteristics and psychiatric comorbidity in S o Paulo, Brazil. A three-step cluster sampling method was used to select 1,464 subjects aged 18 years or older. They were mainly from families of middle and upper socioeconomic levels living in the catchment area of Instituto de Psiquiatria. However, this area also contains some slums and shantytowns. The subjects were interviewed using the Brazilian version of the Composite International Diagnostic Interview version 1.1. (CIDI 1.1) by a lay trained interviewer. Answers to CIDI 1.1 questions allowed us to classify people according to their psychiatric condition and their headaches based on their own ideas about the nature of their illness. The lifetime prevalence of "a lot of problems with" headache was 37.4% (76.2% of which were attributed to use of medicines, drugs/alcohol, physical illness or trauma, and 23.8% attributed to nervousness, tension or mental illness). The odds ratio (OR) for headache among participants with "nervousness, tension or mental illness" was elevated for depressive episodes (OR, 2.1; 95%CI, 1.4-3.4), dysthymia (OR, 3.4; 95%CI, 1.6-7.4) and generalized anxiety disorder (OR, 4.3; 95%CI, 2.1-8.6), when compared with patients without headache. For "a lot of problems with" headaches attributed to medicines, drugs/alcohol, physical illness or trauma, the risk was also increased for dysthymia but not for generalized anxiety disorder. These data show a high association between headache and chronic psychiatric disorders in this Brazilian population sample. (+info)
Estimating the prevalence of mental disorders in U.S. adults from the Epidemiologic Catchment Area Survey.
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The National Institute of Mental Health Epidemiologic Catchment Area Survey is a comprehensive, community-based survey of mental disorders and use of services by adults, ages 18 and older. Diagnoses are based on the criteria in the "Diagnostic and Statistical Manual of Mental Disorders," third edition, and were obtained in five communities in the United States through lay-interviewer administration of the National Institute of Mental Health Diagnostic Interview Schedule. Results from the survey provide the public health field with data on the prevalence and incidence of specific mental disorders in the community, unbiased by the treatment status of the sample. The population with disorders is estimated, and the survey findings that respond to some of the most common requests for information about the epidemiology of mental disorders in the United States are highlighted briefly. Based on the survey, it is estimated that one of every five persons in the United States suffers from a mental disorder in any 6-month period, and that one of every three persons suffers a disorder in his or her lifetime. Fewer than 20 percent of those with a recent mental disorder seek help for their problem, according to the survey. High rates of comorbid substance abuse and mental disorders were found, particularly among those who had sought treatment for their disorders. (+info)
Paternal age and risk for schizophrenia.
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BACKGROUND: Previously reported associations between advancing paternal age and schizophrenia could be due to an increase in paternal germ cell mutations or be confounded by heritable personality traits associated with schizophrenia that result in delayed parenthood. AIMS: To investigate this association while adjusting for personality traits related to poor social integration in the subjects. METHOD: A cohort of 50,087 adolescent males was followed up by record linkage to determine hospital admissions for schizophrenia between 1970 and 1996. RESULTS: Advancing paternal age was associated with an increased risk of developing schizophrenia in a 'dose-dependent' manner. The adjusted odds ratio for each 10-year increase in paternal age was 1.3 (95% CI 1.0-1.5; P=0.015). CONCLUSIONS: Advancing paternal age is an independent risk factor for schizophrenia. Adjusting for social integration in subjects made little difference to this association, consistent with the hypothesis that advancing paternal age may increase liability to schizophrenia owing to accumulating germ cell mutations. (+info)
Assessing the value of assertive outreach. Qualitative study of process and outcome generation in the UK700 trial.
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BACKGROUND: It is unclear why intensive case management (ICM) failed to reduce hospitalisation in the UK700 trial. AIMS: To investigate outcome generation in the UK700 trial. METHOD: A qualitative investigation was undertaken in one UK700 centre. RESULTS: Both intensive and standard case management practised individual casework, employed assertive outreach with comparable frequency, and performed similarly in the out-patient management of emergencies and in-patient discharge. However, ICM was advantaged in managing some non-compliance and undertaking casework that prevented psychiatric emergencies. Absence of team-based management and bureaucratised access to social care limited the impact of these differences on outcomes and the effective practice of assertive outreach, although this was relevant to only a sub-population of patients. CONCLUSIONS: The impact of ICM was undermined by organisational factors. Sensitive anticipatory casework, which prevents psychiatric emergencies, may make ICM more effective than an exclusive focus on assertive outreach. Our findings demonstrate the value of qualitative research in evaluating complex interventions. (+info)
Estimation of subjective stress in acute myocardial infarction.
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BACKGROUND AND AIMS: Mental stress is considered to be a precipitating factor in acute coronary events. We aimed to assess the association of subjective or 'perceived' mental stress with the occurrence of acute coronary events. SETTINGS AND DESIGN: Prospective case-control survey was carried out in a referral teaching hospital. SUBJECTS & METHODS: Consecutive patients with acute myocardial infarction and ST elevation on electrocardiogram who were admitted to the Coronary Care Unit of a referral teaching hospital were enrolled in the study as cases. Controls were unmatched and were enrolled from amongst patients with coronary artery disease who did not have recent acute coronary events. Subjective Stress Functional Classification (SS-FC) for the preceding 2-4 weeks was assessed and assigned four grades from I to IV as follows: I - baseline, II - more than usual but not affecting daily routine, III - significantly high stress affecting daily routine and IV - worst stress in life. STATISTICAL ANALYSIS: Proportions of different characteristics were compared using chi-square test with Yates continuity correction. Student's unpaired t test was applied for mean age. 'p' value of < 0.05 was considered statistically significant. RESULTS: SS-FC could be reliably (99%) and easily assessed. Eighty (53%) of the total 150 patients with acute MI reported 'high' levels of stress (stress class III and IV). This is in contrast to only 30 (20%) of 150 healthy controls reporting high stress for the same period (p value < 0.001). CONCLUSION: Patients with acute myocardial infarction report a higher subjective mental stress during 2 to 4 weeks preceding the acute coronary event. (+info)
Implications of carrier identification in newborn screening for cystic fibrosis.
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OBJECTIVE: To investigate the psychosocial implications for families whose infant was identified as a cystic fibrosis carrier by newborn screening. DESIGN: Prospective psychosocial assessment. SETTING: Primary care. RESPONDENTS: STUDY: (a) families of an affected infant identified by screening (n = 9); (b) families of a carrier infant identified by screening (n = 10). CONTROL: group of mothers from the general population (n = 82). INTERVENTIONS: Questionnaires and semistructured interviews. MAIN OUTCOME MEASURES: Attitude to screening, assessments of the mother/baby relationship, anxiety, wellbeing. RESULTS: All families were in favour of screening, with no evidence that the mother/baby relationship, anxiety or wellbeing had been adversely affected. Parents, however, did identify problems in terms of the service delivery protocol and genetic counselling practice. CONCLUSION: Six months after disclosure, carrier identification was not perceived by parents to be problematic. (+info)